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HomeMy WebLinkAbout03-02-10 15056051047 REV-1500 EX (OS-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poaox2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 1 1 5 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 0 1 6 8 9 7 3 1 l 1 2 2 0 0 8 0 8 1 7 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI C a s s w i n t G e r a l d i n e E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW G~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O s. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE CO MPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Tel~one Numbe~r~ S A N E M A L E X A C d ; N D E R 7 1 7 ~~~ 3 2~ 5~ ~.; ~+, Firm Name (If Applicable) REGI ~j4plILLS I.iSE ON~.Y` _ First line of address 1 4 '8 S BE a l t i m o r e Second line of address City or Post Office D i 1 ;l s b u r g S t r e e t State ZIP Code L p A 1 7 0 1 9 ~~ ~~~ ~ r -v ---I .. ~ :n 3, © , ~ ~_, DATE FILED Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE pF PERSON RESPQNSIBL~ FOR 6iLING RETURN DATFi i ADDRESS 8 Cet~r Aver, MechaniCSbtarg, PA. 17055 SIGNATURE PREPARER OTHE~T~N R~A IiE I~,T ~.3 /f ADDRESS / '~ 48 S Baltimore t., Dillsburg, PA. 17019 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: 1 6 0 1 6 8 7 3 RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. • 2. Stocks and Bonds (Schedule B) ....................................... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. • 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 6 0 ~ 8 4 • ~ 5 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 6 Q 0 8 4 7 5 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 7 9 6 % . 0 0 10. 9 9 ( ) .............. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 10. .. 1 7 ' % 9 9 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 8 1 4 4 . 9 9 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 5 1 9 3 ~) . % h 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 6 0 0 0 ~ ~ an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 4 5 9 3 9 ~, % 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable 8 2 3 4 4 5 4 16 1 5 5 0 4 6 . at lineal rate X .o . , 17. Amount of Line 14 taxable 1 3 7 8 ~ 1 9 at sibling rate x .12 1 1 4 8 4~ 9 4 17. . 18. Amount of Line 14 taxable at collateral rate X .15 18. • 19. TAX DUE ....................................................... ..19. 2 ~ ~ b • E~ 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 J REV-100 EX Pale 3 File Number 21- (~r 1152 Decedent's Complete Address: DECEDENT'S NAME -GIIZAL~IIVE-E_ GASSWJIVI'-alk~a _ C~AALDIldE_E. SIEI' ~11j' STREET ADDRESS _ _ - - -- _- - _..4837 Fist Trirxile Boed _ __ __ - _ _- _ _ -_ CITY ~C~I11CSbUT'g ?-STATE P8 - _ - - ~ ZIP -- -_ _ - 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2.928.65 2. Credits/Payments A. Spousal Poverty Credit -_ _ _ -- B. Prior Payments - C. Discount __ _ - - _ __ Total Credits (A + B + C) (2) 2,000,00 3. Interest/Penalty if applicable D. Interest - _ - enalty Total InterestlPenalty (D + E) (3) 2575 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 954.40 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : .................................... ....... ^ ~] c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ ~] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-t.509,E7c • p~Y)).. ._.... _._ .. - ~+ SCHEDtiLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF GQ~ALDIlVE E . G~ a/k/a GE~AL,DIl~IEE E . STEWART GAS~SWli~r Include unreiml;ursed medical expenses. ITEM i " NUMBER __ DESCRIPTION 1 Crnanty Meadows Assoc. Acct no. 75528 -Patient fmnd 2. Higl~rk Premium refund 3. M & T Bank C~ecld.ng Acct no. 57697418 4. American Enterprise Tnvestrnent Services, Inc Mutual Fund acct no. 010116794982002 5• American Enterprise Investrnent Service, Inc- SPS Advantage Acct No. 000541902029021 FILE NUMBER 21- OPr 1152 AMOUPJT 2191.06 67.05 1,325.88 27,110.64 29,390.12 All items of personal property speciffically bequesthd in Items 2,3,4,5,6 of will were given to designated beneficiaries, All other personal property, household goods etc, bequeathed in Item 7 sold at public auction at Haar's on July 1 & 8, 2005 All items given December 2004 before she went to assistant living. _. TOTAL (Also enter on line 10, Recapitulation?. _ ~ __._~ _ -~.~ -- - - .._ - - - - - -~ ~- __ -- g _ ._ - - _ ._ --• - ,s ~ _~ - - - Me~TBank L.h1C~'S ~~ what's unportat~ Mechanicsburg Office so [f you have any questions, please :all our Telephone Banking Center at 1-800-724-2440 oday's Date: Business Date: 1/20/2008 11/20/2008 ime: 10:34 AM pecking Deposit $1,325.86 vT k**8700 ~tal Balance: $1,325.86 6117 /03 25 M ~ ~SwINT: ;count with M&T Bank. I think you will find a high level of ;fi''s Mechanicsburg. w i 11 be c 1 osed ursday November 27 'r this opportunity to meet your banking needs. Please contact , financial requirements. / ~,~•~~ ti 1 ~ ~~ .. ~ ; __ ~ ~. Z. --- - ~t ~ . O _' - ~ V ~. - i ~_ a ~ 3 t rn :~ ~ ~ ~ __ ~, ~ U L Z ~ ~ ~ c o a m a z °; a ¢ m m O U ~ ~~~ O D ~ OU MEMBER FDIC ., _ _ .. M -- _~.~ - W ;.y_ ..;, RiverSource Life Insurance Company RiverSource Funds Ameriprise Certificate Company Ameriprise Brokerage 70100 Ameriprise Financial Center Minneapolis, MN 55474 November 18, 2008 Thomas F. Benkovich Ameriprise Financial Services, Inc. 4661 Trindle Road Suite 300 Camp Hill, PA 17011 Dear Thomas F. Benkovich: We have received notification of GERALDINE E GASSWINT's death. Account values as of 11/12/2008 are listed below. Account Information Mutual Fund Account Number Ownership 0101 1679498 2 002 Individual SPS Advantage Account Number Ownership 00054190202 9 02 1 Individual Cash Management -Mutual Fund Account Number Total Value # of shares Asset Value Per Share 0101 1679498 2 002 $27,084.46 27,062.970 $1.000 SPS Advantage Account Number Total Value 00054190202 9 02 1 $29,390.12 Irv ~~,~_' 7~7 j d 7',`~ .~- ~-~ I A~ot.'t ~alme:5trateglC t"Io Bt"vi ,~dv~an#~a ~EFYAI`dlNE ~ ~,~.lT Ac+~t i~o:t1~4 ~2 ~ ~e+~t Tyke: ~~-C~t~l~l s y 3 3 Y'§ ~ _ R'~ $, f~„ G~.;/k ,{~~ ~~~ T #v. ''t~Pa ~ *+'§a`,. 4 ,L~..< .x M I s,:ii a .,~r~`.#F~a~ ~M ~, ~ $?~~.kr~ r.& : y w..~ g~.;• ? ~ ~-..3x;i.. F t ~ t z, v&~. ~ ~x ,°'. ~_~.€~~`< ~ r>~ .... ~. ~ a,~ a 3~ ~ ~yyr Y ~•• y}r.; ~/~{p~+iy •p~y~ .y`~~= Y +~Fy~~.y~..~/~~~ $~~€;~y}r,€c ~f ,..:~.;tse rx~f%~.ro~ufbn ~f",#>kxas &;~`i~~~§> ~~y~~[~~~~,~~:; "~d~ac ,.~y~ ~ L.'V/rli ~~ ~1 •lFV +~ ~ ~ ~~l" `~~ f11rw4 Wei ' ~ 7+~~i ~*~.~~~~:- ;. ~+~i+M ~fy/t~.~~.. tt ~}~ ~j~~ ~~r ~y l,~F~ ~il~~ ~ ~ Vii! ~.1~{'~W}~ ` Thy 7~i.Rti~~ w~' ~aVV y~.~,~i.7:.. AcCC Tull. !~,~, t r REV-1511 EX+ (12-99) ~. ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ADMINISTRATIVE COSTS w ~f+-i c yr GQ~ALDIlVEE E. OE~~SWIl~Tr a/k/a (~ZAL~IlVE E. SI'F~ninAR'I' ~~W~ FILE NUMBER 21-~6-I152 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: t . GIl~IGRICH rg~s M~N~rlavr AMOUNT 1950.00 B. ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative(s) Dolores L Her-f'z1 er 2900..00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address $ ~r Avenue City ~ChaI]1CS~ltY'g State Pa Zip 17055 Year(s) Commission Paid: 2010 2. Attorney Fees J~ jvj• ~~~~. 2900.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Will. Ct>anbPSland County 177.00 5• Accountant's Fees 6. Tax Return Preparer's Fees 7• Flung Inheritance tax return, Inventory 15.00 8. Notary fees 20,00 9. F;1;n~g estate release 5.00 ~_ TOTAL (Also enter on line 9, Recapitulation) $ _7,967.00,__ _ - ~- „ - -, ~.~:_ ~- - t. - _ -.T_a _. ~ - - - - - - RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sqware Carlisle, PA 17613 GASSWINT GERALDINE E * DUPLICATE Receipt Date: 11/20/2008 Receipt Time: 09:01:34 Receipt No.: 1054797 Estate File No.: 2008 -01152 Paid By Remarks: JANE M ALEXANDER ESQ JN ------------------------ Receipt Distribution ----- -------- _______ ____ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 135.00 CUMBERLAND COUNTY GENERAL FU AUTOMATION FEE SHORT CERTIFICATE 15.00 5.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FU FU JCP FEE 12.00 10.00 -------- CUMBERLAND COUNTY BUREAU OF RECEIPTS GENERAL & CNTR FU M. Check# 3553 -------- $177 00 Total Received......... . $177.00 Jan 05 09 10:28a Gingrich Memorials zn YZ~ ME~O~t][ALS Since 1922 5243 Simpson Ferry Rd. Mechanicsburg, PA I?050 (717) 766-5622 • Fax: (717) 766-8007 www. f?int=richmemorials com ron(a~gingrichmemorials. com R FORM 717-766-8007 Foundation 6y_ ~ ~~s ^ Carved Lettered ^ Drawing Required ^ Drafter ^ Sandblast By Manufacturer SOLD TOt:-- JQne '( ~" telcgtnOleY' . /' 1 t~ `ern ~.~ - a.l • e tn1~ ~'c- ~ F g ~G~en6~11,~~YQ~ ~ ~s G S~ b~r'~ ~=,n S S W l Mt~1 Q S . ~.lLt W1or-e S~- ll sbt~ra ~P ~ I ~ a la Phone (H) `~ 3~- ~f $ I~ (W) Date of Order p.l No. ~- 70654 Supplier Ack. # Date Recd Found. Ordered Position Verified Cemetery Ko I l I tna y tee Location Center Over _ ~ Graves Lot # Approx. Date of Completion ' ~ ~ Lettering Ma,.`~ws ~QtrY~ev- ~oSe. - RE G" E R ~ t--~ l Jul ~ E . 5-C E W ~~-~ G A s s W~ .~ ~" Rub «, ~ oV. tZ ZooB iq zb ~ N , Spelling and dates have been approved. Type of Memorial S~Y1C~~.o ~t-~n2.e, Material S C3" ~obe Wl ~/~ Size ~ x r~ X Fnish O ~, Size oZ~ X ~_ X ~ Finish ~ o~VL~ie ~ r7'Y`Qlu C~ Wi ~,~ Misc. Design Location ^ Vase S A, ^ Corner Posts ~ - Agreement A 50% deposit is required to commencement of work Price g Agree to pay staled balanoa upon erection regardless of labor troubles or shipments or any other good reasons. This order or contact r~ cannot be cancelled by customer unless agreed by Moth parties. The article herein mentioned shall remain the property of James R. FOUndatlOn $ _ f Sy Ginyrkh Memorials until paid in full and they reserve the right to remove the same is not paid as stated. t a tee to careful) bldh Q, pn ~ ~~'- --- 9 y proofread all names and dates for accuracy and accept full responsibility for any errors or omissions. THERE WILL HE AN ADDfT70NAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED Oil THE CEMETERY. I further agree to pay the balance stated for the work performed under this contract within thirty (30) days of receipt of the final invoice TOTAL ~ ~ 5 a ~ ~-' and furiher~pree that interest shall accrue at the rate of one and one-half percent (11'i%) per month on the unpaid balance owed to James R. Gingrich Memorials not paid within thirty (30) days of the invoce date. !n addition thereto, I agree It it becomes necessary DEPOSIT $ for James R Gingrich to institute legal proceeding to collect any funds due Irom me for my account being past due thirty (30) days, Balance Due to pay aq court costs and attorneys fees incurred »y James R. Gingrich Memorials to collect the same. -16G _ ~~ ~ 6 Upon Completion $ Dealer Customer (I further agree that the abov ames, sp frig, and dates are correct) _,,_~__~~__.,~,,.. ~_ WHITE-Offtce __ YELL01tV=P_roductinr~___~-,,~mer ._GOLDENROD-Brartsi~ __ _. ~_ ,. _ -ter, ,.___ _ -. ._.. .:~ - - _ _. _ _ - _ _ __ _ _ _ _ _ ~ _ ~ ~~~ - ,.._R - - . _ _ _ ~-_-_,_ - - -. - - :_ ~ . -. _ - - --- ,. _ - _ ~ - ~: ~ _ -- - _- ._.. .~ - _ -~_ :. ._-.---- --. ._ ~: _ - ~.T REV-t t (1-97( ~ _ Tom, _,._~ °° .._ a:r _ ~-~ ~ SCHEDULE Vii' C,OMMONVVEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN ~ RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ES7ATE OF C~RALDIlVE E. GASSWIlVI' a/k/a C~ZALDIl~IE E. ~IE~IAKI' G;A~ FILE NUMBER -- -__._ _ 21-01152 Include unreimbursed medical expenses. ITEM NUMBER _ DESCRIPTION 1. -- AMOUNT ~ M & T Deluxe Checks 19.50 2• ~ Penn Credit Corporation -Debt of Decer~dant ! Inheri-tance tax on furuls received fran Thelma Jtmper estate 158.49 i s :. -- -~--- ~ O7AL (Also entei on line 10, Recapitulat(on) I ~ 177.99 ~~ . _dk~rai s'heefs of the same s(ze} ,.~ .:- ~ ,^ ~_ _.,~ _ _. ,... ,~ -,. _ sir , .~, _ .. _ - - -- P O BOX 988 HARRISBURG, PA 17108-0988 2009/03/23 #BWNMZSX #073347170004# GERALDINEE GASSWINT 8 CEDAR AVE MECHANICSBURG, PA 17055 800 900-1362 Hours: Mon-Thur Sam-10pm, Fri Sam-Spm, Sat Sam-12pm (Eastern Standard Time) NOTICE OF COLLECTION [~A ` [A.~L The nccomUon or Cn~ and CoOecUon Prafecdanrlc Mew6er CLIENT: PA Inheritance Taxes TOTAL BALANCE DUE: $158.49 Our client has referred your delinquent account(s) referenced below for collection. Our client is serious about collecting all monies owed them and I am sure your intentions are to honor your debt. Send payment using the enclosed envelope or you may go online to make payment or contact our office to pay over the phone. Please note the amount referenced above does not include accruing interest. For current balance or payoff please contact our office at the number above. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or an thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from receiving th s not en that you dispute the validity of this debt or any portion thereof, this office will obtain verification of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice this office will provide you with the name and address of the original creditor, if different from the current creditor. This is an attempt to collect a debt by a debt collector and any information obtained will be used for that purpose. The important rights included above apply to each account individually and you have the right to dispute any or all of the accounts included in this notice. In the event you choose to exercise your important rights included above please indicate which accounts(s) you are disputing. SERVICE RENDERED BUMPER , THELMA M SERVICE DATE ACCOUNT NUMBER BALANCE EMPL ID: 11 SEQ #: 2000/00/00 2105-053206113539 $158.49 /,r'__~f ~~%~ .~_ _~ ~ ~~ .~ F !. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Detach and return the bottom portion with your payment for account identification. 2009/03/23 GERALDINEE GASSWINT We accept Visa, MasterCard and check by phone 8 CEDAR AVE Please include a check or fill out the information below MECHANICSBURG, PA 17055 if you wish to pay by credit card. ID NUMBER: 07334717 BALANCE: $158.49 Check one: ^ Visa ^ MasterCard Card #: _____ Expiration Date: / % - - - - -' - - - Signature: REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNE®u~~ ~ BENEFICIARIES ttifAlE U NUMBER I 1. 2. 3. 4. 5. II F Geraldine E. Gasswint NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) Dolores Hertzler 8 Cedar Avenue Mfechanicsburg, PA. 17055 Robert C~asswint 25 Deardorff Drive Etters, PA. 17319 Jack J. Stewart 3 Spring Lane Elizabethtown, PA. 17022 Kay & Patricia Gass~rint 604 Mt. Rock Road Carlisle, PA. 17013 Thelma Jt>I<nper -pre deceased 6/5/05 FILE NUMBER 21-0-1152 RELATIONSHIP TO DECEDENT Do Not List Trusteelcl sister stein-son son stepeson & wife sister AMOUNT OR SHARE OF ESTATE 1/4 residee 1/4 residee 1/4 residee 1/4 residee ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1~ The Church of the Brethren 301 Gale Street 2'000.00 Mechanicsburg, PA. 17055 2. The Church of the Brethren Home, Cross Keys V;lliage 2,000.00 P.O. Box 128 New Oxford, PA. 17350 3. 'The Church of the Brethren, Aid Society 1,000.00 P.O. Box 128 New Oxford, PA. 17350 4. The Church of the Brethren, Campo EDER 1,000.00 914 MDUnt Ho Road Fairfield, PA. 17320 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ 6.000.00 T :~ --- ;~ _~ ~ - _ T - - - - - ~,.` .. _,. ~-~--. h _ - - L!1S`- ?~tILT~ 11.T'~~D TI~ST11i~I~IT OF GERALDIT••JE E. GASS~~tIt~1T I, Glr~11.LDII•~F E. GASSI~tII~:T, of the borough of T~•Techanicsburg, Coux~ty of Cuml:Uerland and State of Pennsylvania, being of sound and disposing mind, r~nemory and and©rstanding, do make, publish s.nd declar. e this my Last ti~,~ill and Testament, hereby revoking and making void any and all prior tiail_ls by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after z~~y decease as the same can be conveniently done, and in this respect, I direct that all estate, inheritance and success ion taxes that may be assessed in consequence of my death, of whatever nature a.nd by whatever jurisdiction imposed, shall be paid out of the k~rincipal of my general estate to the same effect as if' said taxes were expenses of administration, and that all propert~T includable its rly taxable estate, whether or not passing uticier this l,~till: shall be free and clear thereof. 2. I give and bequeath my dry sink and chest of drawers to my stepson, l~.OBL~T GASSUJII~~'I'. 3• I give a.nd bequeath nay grandmothers s dry sink to my sister, DOLOH.TS IiERTZL~. _ _ ~F --- , ~~ .. __ - - . _ _..._.,. -~...~.w_.r.~ _ . _ __ - - _ =-__:__ .. .. ~ -- _ _ .~ .. _ __ . -_ :~ ~ :. ~~. . I give and bequea•~h any aut;oriiobile which I may own at the time of my decease, to rly son, J~ACIi J. STE~rTART. 5. I give and bequeath my t~•ro~drawer walnut bedroom dresser with mirror, and my five-drai~rer bedroom chest ti~rith mirror, to my sister, DOLOR_~S III~RTZLL~~ . s I give and bequeath my drop leaf table, my oak rocker and my old fashioned table lamp to my sister, DOLORES ~IERTZL~R.. 7. I give and bequeath all the rest of my household goods, furniture, personal belongings and/or tangible personal belongings to my sisters, TII~~LI~~iA. T•I. JUI~~IP:CR and DOLORES ~iERTZLER, share and share alil~e, or to the survivor of said two individuals, absolutely, should either of them predecease me. ~. I give and bequeath the sum of Two Thous and (;p 2, 000.00 ) Dollars to TIiF CINRCH OF TI-IE BRETIff~EN, Gale a.nd Apple Drive, T~•Tecl~anicsburg, Fennsylvania. . , ~ :_ .~_ ~~ _ _ - -- - __ __ ._ _~_ _ w __ .. - . ~2_ ~. .C ~;_i.ve and bequeath the sum of Ttiro Thousand (~2, 000.00) Dollars to the CI~[JI~CI~. OF `.CITE F31~ETHREI~t IiOI~IE, at Cross Keys, Pennsylvania. 10. I give and bequeatl~ the sum of One Thousand ($1,000.00) Dollars to ~th© CFIUPCIi OF TIiI~ I;RETIiREN AID SOCIETY, of Cross Keys, Pennsylvania. 11. I give and bequeath the sum of One Thousand (~l, 000.00) Dollars to CAr~~IP EDER, of the CIiURCIi OF THE DRETHRET~~t, located near Chambersburg, Pennsylvania. 13. I direct that all the rest, residue and remainder of my estate, of z-~rhatsoever nature and t~rheresoever the same may be situate, shall be divided into five (~) equal shares and that the same be ~~aid out and distributed as follows, to wit; (a) I ~~ive and bequeath ono (1) such equal share to my s is tor, DOLOPI;S IiEFtTZLER . (b) I give and bequeath one (1) such equal share to my sister , TIIEL?-~IA ICI . JUI'~ZPER . (d) S give and bequeath one (1) such equal share to 111y son , JA C ~~ J . ST L'~~JAR T . (e) T give and bequeath one (1) such equal share to xny stepson, ~~~>..AY CrAS t~~•rIT•~;T and to ~lis ~1ife , PATRI CIA GASSUJIZ~JT, s~iare and share ali~se, or to the survivor of said two individuals, absolutely, sl~ioulcl. eithex~ of them predecease me lid « Iior the purpose of facilitating the settlement and distribution of my estate, I authorize and empower r1y personal representative or representatives to sell any and all real estate which I T~lay oj,rn at t'ne time of my decease, at either public or private sale or sales, LASTLY, I nominate, constitute and appoint my sisters, TI~ELI~~u4 I-I. JUi-IPEF and DOLOI~~S HERTZL~, Co-Executrices of this my Last <<~ril1 and Testazuent, and direct that they be excused from posting bond or other security for the faithful performance of their duties in any ,jurisdiction. ITd Z~TITNESS UJIIEREOF, I have hereunto set my hand and seal ,.~ this _ , ~~~: , day of P•lovember, A. D. , 199L~... Geraldine E, ~'asstrint (SEAL ) --- . _ .~_ - ~ - ~-- . _ „ _. .. ~s _ ..~.~ Signed, sealed, published and declared by the above Warned, GER~ILDI.~~~ ~. GI~aS1~III~3T, as and for her Last I~~ill and Testailrent, i.n the pr. esence of tts, z~rho have subscribed our names hereto as ti~Jitnesses, at the request of said testatrix, i.n her presence a?Zd in the presence of each other. ~-: w ~,. - . _ . _ ~-: _._ _- r -- _ } COMMONWEALTH OF PENNSYLVANIA } SS. COUNTY OF CUMBERLAND ) I~ ~,.:-.:,~.,i=,~_JL_ _i~:J .,~ ~.,~._=~>,_;. .--~=- the testat 1~-;-~_ ' ~ 111. whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before me by ~~~~:=~_=~~lir~ ~~~ t" _ ~~ n `~'~:r-~~`~~" , the testat • n.. this ,~ ,- z:._ day of ~' o ~,T~r~b°x*^ A. D. _ ~ c~~l~ ~ ~~ JJ// ` ,, t ~r ~ ~+.~..~ ~°~- ~ ~~ E~fdr~ S~rdl COMMONWEALTH OF PENNSYLVANIA ) o+~E`"'a~ %~-+~ S S . ~ 'ssicn F~:+'os Nov ~i ~c~ ' ~Yhrsr~ra ~-----~.__ COUNTY OF CUMBERLAND ) ion °f ~,t We , the undersigned ~. .•._..'`` `~ `.'':' '` =T,_,;`._ ,_, and ``'.~- ":~'~ ?.,. L~:~~`7 1:?T-r:~s;_~-';•..' .. ` E_ y _,~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat ~~i ~s ~ u 1~'_'iLDTT•;7T,, ,-;, :, :, ~-,1 ~:,. ,rT.~rn sign and exe- cute the instrument as~~/her Last Will and Testament• that the said " ,_ ~"~'~'~= __ ~ ; ;.r-,-, --, -~ ,; -, - ' testat I'l?~~" , ,_,-__, LJ.~'i.,_I_.~_. 1;;.J l'J; ~._,,,~~~,~~~~ _~t-~f' , executed it as _~if her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testat~'1~ signed the Will as witnesses; and that to the best of our knowledge, the testat~'?T{ was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, ~uress or undue influence. Sworn and subscribed to before me this ~''~ day of ~• : - - =~~. - . ,.. r ~ _: _ _.. ,,. ''JCL - ~ - _ -4'~ __ -- . b _. 't~?'- ~,